Unscheduled Admissions for Suspected Seizures in the NHS in England 2007-2013
Ambulatory care sensitive conditions (ACSCs) are those conditions for which timely and effective ambulatory (or non-emergency) care can reduce the risk of emergency hospital admissions. Frequent seizures and frequent attendances at hospital are associated with poorer quality of life, high levels of stigmatisation, high health-care costs, increased mortality and shorter life expectancy. So improved ambulatory care for people with epilepsy and effective alternative care pathways (aimed at avoiding emergency department (ED) attendance) may have the potential to make major improvements in the lives of people with epilepsy and to make major cost savings for the NHS.There is very little good quality data in the medical literature to quantify the exact scale of the problem of unscheduled admissions for seizures and the associated costs. There is some evidence that there is significant geographical variability in unscheduled admission for seizures which may reflect quality of service provision.
The Hospital Episode Statistics (HES) in-patient database was searched for emergency admissions in the NHS in England during the period 1 April 2007 and 31 March 2013 (six financial years). We searched for all neurological conditions using ICD-10 diagnosis codes. We calculated an age and sex directly standardised rate for the number of emergency admissions for each Primary Care Trust (PCT). The numerator of the rate is calculated from Hospital Episode Statistics (HES) inpatient data and the denominator is the PCT population estimate from the Office for National Statistics (ONS).
In the NHS in England between 1 April 2007 and 31 March 2013 there were a total of 315,293 emergency admissions (after exclusions). Unscheduled admissions for seizures are the biggest single cause for emergency hospital admissions amongst all the neurological conditions. 93.5% of admissions were via EDs and 3.7% were by GPs. Men (54.8%) are admitted more frequently than women (45.2%), the age distribution of emergency admissions is bimodal, the number of emergency admissions for epilepsy seems to be rising annually and there is significant geographical variability.
Epilepsy is an ACSC and is the most numerically important neurological condition in terms of in-patient admissions. Improved ambulatory care and alternative care pathways have the potential to make major improvements in the lives of people with epilepsy and to make major cost savings for the NHS but more research is required to allow rational commissioning decisions and the design of effective alternative care pathways.
- Julian Hick, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
- Richard Grunewald, Health IQ, London, UK
- Richard Jacques, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
- Markus Reuber, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
- Mike Campbell, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
- Rebeka Morley
- Jon Dickson, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK